20040683.pdfV
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEIN�A E OF B SINES-S-1
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CITY zip
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NAME
ADDRESS I
C ZIP
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PHONE
ADDRESS
CITY ZIP
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TE EPI
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STATE LICENSE NUMBER
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�W7f��f/�/o ._0/11
PROPERTY�TT AC NT
PA, EL
221 Z-4
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11 NEW
�_�ESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRAD
CYDS
DEMOLISH
TANK
AGE
RETAINING WALL
..�AF
CAFPORT
C
ROCKERY
(TYPE OF USE. BUSINESS OR AqIVITY) EXPLAIN-
—1
r4:0" I L-j I -Pic -
NUMBE�
OF
NUMBER OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE fi
Oc:� I
_5
CEIL 4
ION DATE CHECKED BY
rl—
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x FT
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBEW�96
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THP4WItNJER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
AN; AN IN DOING THE "RK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
rNV 10 LAT t N OF THE LABqR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN C
/OWPfTSATI�"I S . URANCr�D RCW 18,2T
SIGN7ATU )W DATE SIGNED
x-1 IL
41�1 �or
_LP
ERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
J013
ADDRESS
SUITE/APT#
PLAT NAME/SUBDIVISION NO. =N777
7
L I D,
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E.
L FEE S
FE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved E3
RW Permit Required El
Street Use Permit Roq'd E3
EXISTING PROPOSED
inspection Required
sidewalk Required
REQUIRED DEDICATION— FT
UndergrMind
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTSOLIDRAINAGE
1)
ERING REVIEWED BY
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VARIANCE OR CLI SHORELINE OR ADBI I INSPECTION BOND
RECD POSTED
EIYES �(NO I S --�
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EX PT ALLOWED PROPOSED ALLOWED PROROSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FR T LipDE REAR
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PARKING LOT AREA NNING DATE
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REO'D I PROVIDED 16 e� 6 1 1
REMARKS
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SPECIAL INSPECTION
ZCCUPANT
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REMARKS
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PROGRESS INSPECTIONS PER UBC 108/IBC109JIRCID9 FINALINSPECTiON REO'D
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VALUATION
$ lt'�
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
LandscapeInsp.
Total Amt. Due
:5
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-02,20
APPLICATION APPROVAL
This application is not a ponnit until signed by the'
Building oilicial or hisilier Deputy. and Fees are paid, and
receipt is acknowledged in space provided.
OFFI I IG DATE
"�/J. �� t19
JjF1 EASED 13Y DATE
A 1 1 tr4l 1U14 QA 1 1%3%3%3
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK OWNLH GOLD ASSESSOR
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Date:
CITY COMY
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STANDARD DRAINAGE DETENTION SYSTEM
WORKSHEET
ADDMS PHONE:
DATE:
*****DESIGN DATA*****.
IMPERVIOUS AREA PIPE DIA PIPE LG ORIFICE
L
DCTENTION PIPE LENGTH OCKING LID
FINISHED GPtW XTYPICAL)
1 tt MINIMUM I
'60"R aEfflofop or
TIGHTL
C
CONC BOX OR RISER
.5% TO 1% SLOPE
TLC?
OUTLET CONTROL
HIM.
UPPER CATCH BASIN ORIFICE
CONTROL CATCH BASIN
SYSTEM CROSS SECTION
CITY Cury
2'XZ'X6'.DEEP, 4-6- SPALLS OR EGUAL
FROM CONTROL CB 2'X 2'X 3' DEEP, 3/4' CRUSHED ROCK TING GRADE
WASHED KLWAJ
FROM CONTROL OUTLET "IV "
13
UTFLOW TRCNCH, HIM 10' L&C%
PERF PIPE TO BE LEVEL
P
1.5 P
PERF PIPE W/ END CAPS
TR S
PRJ1
DIMOHA�L
T ACIEMEhl"g 'W'Al"NETOWN ROCK
JUPJUP OUTUr
RUNOFF SPREADER -TRENCH
FoOTING DRAINS SHALL NOT -BE CONNECTED TO DETENTION SYSTEM
NOTES.-
1. Call Engineering Division. (771-MO) for a tightline and detention system inspection
before backfilling and for final inspections. � "APPROVED BY
2, Responsibility fbr operation and maintenance of drainage systems on private Property is the
responsibility of the property owner. Material accumulated in the -storage pipe must be flushed
out and removed from the catch basins to allow proper operation. Ile outlet 4c0ntr`O1 orifice DATE
must be kept open at all times. Ic -
mm
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Table I — Detention Pipe Sizes
Impermeable
Required
Area Sq. Ft
Vol Cu Ft—
?,000
50
2500
62
3000
75
3500
87
4000
100
4500
112
"POP0.
125
Note: Allowable Pipe
Materials:
Impermeable
Area Sq. Ft
2000.
2500
3000
3500
4000
4500
5000
Pipe,Diamleter
150 185
30 0
40 28 16
10
50 3 -5, _20
13
60 42 24
15 Required pipe
70
-18 --length in feet
80 56 32
21
90 63 36
23
100': 70 40
25
Reinforced Concrete
Aluminized Steel
Aluminum
CMP Asphalt.Coated
N — 12 ADS (Not permitted on roads)
Table 2 — Outlet Orifice Sizes
Outlet Orifice Diameter (inches)
5/8
5/8
3/4
3/4
7/8
7/8
7/8
Table 3 — Rectangular Catch Basin Requirements
Detention
Max. size
Catch Basin
pipe diameter
knockout
Type
< 182
20
Type 1, C13 15
180 to 24
260
Type IL, CB 16
24N to 36
360
Type 11, C13 19 19 (48' Basin)
361 to 428
42*
Type 11, C13 19 19 (54' Basin)
*Source: Assoc.
Sand & Gravel Co. Standards
5
Revised 3/16/95
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FINAL PROJECT APPROVAL
TO ---
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE------�
nAAWSW
r)
E NGINEERING DIVISION DATE
PLANNING DIVISION DATE��
nXAWSW
PROJECT aeed
SITEADDRES
PERMIT A DATEJNSPE�ED—I-hJL�
DESCRIPTION OF WORK TO -BE INSPECTED
A field inspection was conducted to determine final compliance with.approved plans. Masi approval
denotes that there are no objections from the above signed Department to the release of
pERFORMANCE BONDS and the granting of;
GRANT FINAL PROJECT APPROVAL
I
GRANT pRojECT APPROVAL WITH CONDITIONS NOTED
(3 Copy of CONDMONS given to owner/contractor by inspector
FAILED FINAL INSPECI710N - OUTSTANDING ISSUES
Cop y of CORRECTION NOTICE given to owner/contractor by inspector.
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL.
Date Si
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..................... ei
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Slde.Sewer#�.��
Au'lout Paid$
Date Lssued_..���xp
'Water Meter Size
e7- A1u0untPa'd'--___
purchased
vv*;, Date
r,ONV Itecelpt 72-
Aulount Paid $ RLI,�,o
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